Physician gender and psychosocial care for children - Attitudes, practice characteristics, identification, and treatment

OBJECTIVE. To examine differences by physician gender in the identification and treatment of childhood psychosocial problems. DESIGN. Survey of patients (n = 19,963) and physicians (n = 366) in primary care offices in 2 large, practice-based research networks. Multivariate re gressions were used to control for patient, physician, and visit characteri stics, with a correction for the clustered sample. SUBJECTS. Children ages 4 to 15 years seen consecutively for nonemergent ca re. MEASURES. Physician report of attitudes, training, practice factors, and id entification and treatment of psychosocial problems. Parental report of dem ographics and behavioral symptoms. RESULTS. Compared with male physicians, female physicians were less likely to view care for psychosocial problems as burdensome. They were more likely to see children who were female, younger, black or Hispanic, in single-par ent households, enrolled in public or managed health plans, and with physic al health limitations. Children seen by male physicians had higher symptom counts. Male physicians were more likely to report having primary care resp onsibility for their patient and that parents agree with their care plan. F emale physicians spent more time with patients. After controlling for these differences, female physicians did not differ from male physicians in iden tification or treatment of childhood psychosocial problems. CONCLUSIONS. Male and female physicians see different kinds of children for different visit purposes and have different kinds of relationships with th eir patients. After controlling for these factors, management of childhood psychosocial problems does not differ by physician gender. Improving manage ment of psychosocial conditions depends on identifying modifiable factors t hat affect diagnosis and treatment; our work suggests that characteristics of the practice environment; physician-patient relationship, and patient se lf-selection deserve more research.